KATHMANDU, July 29: Ram Kumari Tamang of Kavre has spent months caring for her husband, Santa Bahadur Tamang, at his bedside in the hospital. For the past three to four months, Santa Bahadur has been undergoing treatment for a neurological condition that has left him unable to walk. He was admitted to the Male Medical Ward at Bir Hospital two weeks ago, and since then, Ram Kumari has remained by his side day and night.
She spends the day sitting on a chair and, at night, sleeps on a mat spread on the narrow floor beneath her husband's hospital bed. The discomfort of sleeping on the cold floor has left her with a persistent cough, yet she has no choice but to continue caring for him.
"It is not easy to sleep on the floor and look after a patient. Someone has to stay with him during treatment, so I have no choice but to be here," she said.
She added that although sleeping on the floor of a crowded ward is uncomfortable, she has no alternative.
In the same ward, another woman has been caring for her husband, Shyam Chandra Adhikari. After initially seeking treatment at National Hospital in Kalanki, the family moved him to Bir Hospital for further care two weeks ago. Like many other caregivers, she spends every night at the hospital but is forced to sleep on the floor because there are no sleeping arrangements for family members.
"I have to spend the night on the cold floor with only a mat. My body aches from the cold, and I worry about catching diseases from sleeping where people walk all day in such a crowded ward," she said.
"Patients use bedpans and urinals here, and I sleep on the same floor. If the hospital had even a small bed beside the patient, it would make things much easier for caregivers."
She recalled that she also slept on the floor while her husband was in the intensive care unit (ICU), while her children continued to sleep on the waiting-room floor near the ICU.
The situation is not unique to Bir Hospital. Most government hospitals in the Kathmandu Valley lack adequate sleeping facilities for caregivers, forcing them to spend nights on cold, often unsanitary floors while attending to sick family members.
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Chet Lal, who has been caring for his father at Shahid Gangalal National Heart Centre for the past week, said he also sleeps on the floor because the general ward offers no alternative. While the hospital provides beds for caregivers in cabins and post-operative wards, no such arrangements exist in general wards.
Similar conditions exist at Tribhuvan University Teaching Hospital, Bir Hospital, Paropakar Maternity and Women's Hospital and Kanti Children's Hospital. Although waiting rooms for ICU patients and cabins have benches or sofas, caregivers in general wards are usually left to sleep on the floor.
"There are separate rooms for caregivers of women admitted for delivery," said Dr Shree Prasad Adhikari, director of Paropakar Maternity and Women's Hospital. "Caregivers of patients in general beds sleep on mats laid on the floor. We have also placed benches in some areas of the post-operative ward."
The Teaching Hospital also provides beds in waiting rooms for ICU patients and benches for attendants of cabin patients, but caregivers in general wards continue to sleep on the floor.
Dr Mahesh Sigdel, a nephrologist at Teaching Hospital, said sleeping on the floor for extended periods poses health risks to caregivers.
"If we add beds for caregivers, we will have to reduce the number of beds available for patients," he said. "However, hospitals should at least provide benches or proper waiting areas for caregivers."
Among government hospitals, Civil Hospital has introduced folding chairs beside patients' beds, a practice caregivers believe should be adopted nationwide.
Most patients admitted to hospitals in Kathmandu are referred from outside the Valley, and many require prolonged treatment. As a result, the same caregiver often ends up sleeping on the floor for weeks.
Dr Dhruba Gaire of Bir Hospital said caregivers frequently become ill themselves after spending extended periods in crowded wards.
"We often see caregivers who were looking after patients later visiting the outpatient department as patients themselves," he said.
According to Dr Gaire, overcrowded wards further increase health risks for caregivers.
Teaching Hospital Deputy Director Dr Pawan Chalise described the practice of making caregivers sleep on hospital floors as inhumane.
Caregivers at risk of illness
Doctors warn that caregivers sleeping on hospital floors face multiple health risks. Bathrooms in crowded wards are often inadequately cleaned, and most hospitals lack bathing facilities for attendants. Eating outside the hospital may increase the risk of diarrheal diseases, while sleeping on hospital floors exposes caregivers to mosquito-borne diseases such as dengue, rat bites that may lead to rabies, skin infections, and cold-related illnesses, including arthritis, asthma and pneumonia.
Dr Gaire said international standards require adequate spacing between hospital beds, separate sleeping facilities for caregivers, and proper sanitation, but most government hospitals in Nepal have been unable to meet those standards.
"At present, we simply do not have enough space to add beds for caregivers," he said.
Sudip Dahal, information officer at Shahid Gangalal National Heart Centre, acknowledged that the hospital has not given sufficient attention to the issue. He said the management would discuss possible alternatives.
Joint Spokesperson at the Ministry of Health and Food Safety Dr Samir Kumar Adhikari said efforts are underway to improve healthcare services through new technologies. He added that although space has been allocated for caregivers in some hospital buildings, many hospitals still lack proper sleeping facilities.
Dr Chalise admitted that while hospitals have expanded patient capacity in response to rising demand, they have largely overlooked the needs of caregivers.
"Teaching Hospital was originally established as a teaching institution, but over the past four decades we have focused primarily on increasing the number of patient beds because of overwhelming demand," he said.
According to him, some arrangements exist in ICUs and cabin wards, but facilities for caregivers in general wards remain inadequate.
He said that under the hospital's quality improvement and patient safety programme, greater attention would now be given to caregivers' welfare. He added that Kanti Children's Hospital has recently introduced folding beds in its psychiatric ward alongside modern patient beds, and the ministry has allocated a budget this year to support similar initiatives elsewhere.
"There should be uniform arrangements for caregivers across the country. New hospital buildings should include such facilities from the beginning, while older hospitals should be upgraded accordingly," he said.
